Uterus leiomyoma
Contents:
Description:
The leiomyoma of a uterus is a true benign tumor of a uterus which in turn belongs to hormonal dependent bodies. The uterus leiomyoma from muscular tissue develops and contains myocytes, connective tissue components, blood vessels, pericytes, plasmatic and mast cells in the structure.
Uterus Leiomyoma symptoms:
At most of women the leiomyoma of a uterus proceeds asymptomatically, however 20-50% of patients have a number of symptoms.
Uterine bleedings (meno-and metrorrhagias) and, as a result, development of anemia are the most frequent complications of a leiomyoma caused by the following reasons:
• pathological transformation of a uterus with increase in its volume and according to the area of an endometria;
• disturbance of sokratitelny ability of a uterus in view of existence of submucous nodes;
• irregularity of morfofunktsionalny changes of an endometria and disturbance of process of its arrangement that leads to premature peeling of the endometria which is not prepared for desquamation yet;
• disturbance of hormonal function of ovaries;
• intermuscular localization of nodes which quite often leads to disturbance of local blood circulation, and also promotes development of a hyper polymenorrhea or dysmenorrhea;
• the bleedings caused by the accompanying endometria hyperplasia.
Pelvic pain, weight in the bottom of a stomach. At emergence of such complications as torsion of a leg of a myomatous node, a heart attack, a node necrosis, the picture of "acute abdomen" – sharp pain in the bottom of a stomach and in a waist can develop, symptoms of irritation of a peritoneum, a leukocytosis, increase in SOE, fervescence.
Disturbance of functions of adjacent bodies. At subserous localization of myomatous nodes, depending on their arrangement, there can be disturbances of functions of adjacent bodies:
• a bladder – change of frequency of an urination (increase or decrease);
• ureters (at an intraligmentarny arrangement of a node) – a hydronephrosis;
• a rectum – at first tenesmus, and then locks.
Squeezing of surrounding fabrics a node of a leiomyoma promotes development of disturbances of blood circulation in the form of a varicosity, thromboses of vessels of a tumor, hypostases, hemorrhagic heart attacks, a tumor necrosis which are shown by constantly expressed pain syndrome, sometimes – fervescence.
At increase in the sizes of a tumor more than to 14 weeks of pregnancy development of miyelopatichesky and radikulalgichesky syndromes is possible. The Miyelopatichesky syndrome is result of spinal ischemia. Patients complain of weakness and weight in legs, paresthesia which begin in 10-15 min. walking and disappear after short-term rest. The Radikulalgichesky syndrome develops owing to squeezing by a uterus of neuroplexes of a small pelvis or separate nerves that causes pain in lumbosacral area and the lower extremities, disturbance of sensitivity in the form of paresthesias or hyperpathias.
Uterus Leiomyoma reasons:
The beginning of emergence of nodes of a leiomyoma of a uterus falls on 30 years when at women somatic, gynecologic diseases and neuroendocrinal disturbances collect. Summing of pathological factors at this age causes vegetative mutation of cells in bodies of reproductive system that probably plays the leading role at a stage of formation of a proliferative component at processes of regeneration of the damaged myometrium cells.
The subsequent growth of nodes of a tumor requires further accumulation of the adverse factors causing a tumoral progression:
lack of childbirth and a lactation by 30 years
abortions
long inadequate contraception
chronic, subacute and acute inflammations of a uterus and appendages
stresses
ultra-violet radiation
formation of cysts and cystomas of ovaries.
Treatment of the Leiomyoma of a uterus:
Treatment of a leiomyoma of a uterus very difficult problem, since despite hormonal dependence, this tumor very a geterogenna.
Surgical treatment
Originally it is necessary to reveal unconditional indications to surgical treatment:
submucosal localization of a myomatous node
the big sizes miomatozno the changed uterus (the total value corresponds to a uterus 14 week durations of gestation)
the uterine bleedings which are followed by chronic hypochromia anemia
rapid growth of a tumor
acute disorder of food of a leiomyoma (torsion of a leg of a subserous node, tumor necrosis)
uterus leiomyoma combination to a recurrent or atipichesky hyperplasia of an endometria,
ovary tumor
prelum of an ureter, bladder, rectum (intraligamentarny, retrocervical leiomyoma, the node which is located in prevesical cellulose)
existence of a myomatous node in the field of a pipe corner of a uterus which is the reason of infertility
cervical and cervical and recervical localization
not regressing and growing uterus leiomyoma at post-menopausal age.
The volume of surgical intervention in many respects is defined by age of the patient.
Up to 40 years in the presence of indications to surgical treatment if technical capabilities allow, make a conservative myomectomy. It is especially reasonable to delete macroscopic myomatous nodes of the average sizes (in the diameter from 2 to 5 cm), there was no their intensive increase in sizes yet. A preferable technique is laparoscopic. At the solution of a question of a conservative myomectomy it is necessary to take a tumor morphotype into account. At a proliferating leiomyoma it is possible to remove several nodes, but further growth is continued by a set of other rudiments of growth. Therefore a recurrence at a conservative myomectomy at a leiomyoma of a uterus takes place in 15-37% of cases.
After 40 years and post-menopausal age in the presence of surgical indications operation of removal of a myomatous uterus since if the leiomyoma did not regress in the first 2 years of a postmenopause, its further existence is followed by danger of developing of an oncopathology (an adenocarcinoma, sarcoma) is necessary. The famous domestic oncologist Ya. V. Bokhman (1987) considered that not regressing uterus leiomyoma in the post-menopausal period is a marker of an oncopathology of bodies of reproductive system.
Risk factors of growth of a leiomyoma of a uterus are: existence of cysts and cystomas of ovaries, a hyperplasia a tekakletok, proliferative processes of an endometria, the untimely termination of hormonal activity of ovaries (an overdue menopause) and excessive aromatization of androstendion in a fatty tissue at the expense of a gross obesity, disturbance of carbohydrate metabolism or a disease of a liver.
